Submitted by Dr. Joshua Corsa, San Juan County EMS Medical Program Director
Editor’s note: This letter was sent to the San Juan County Public Hospital District No. 1 and read to the commissioners during the PHD’s regular meeting on May 27.
My name is Dr. Joshua Corsa, I am the San Juan County EMS Medical Program Director. I’d like to share a little of my background and then discuss my thoughts on the integration of fire and EMS.
I was fortunate enough to grow up on a small island very similar to San Juan Island. I earned my EMT in 1996 and became a Paramedic in 2005. I graduated medical school in 2012 and am a trauma surgeon and critical care physician in addition to being the county EMS Medical Program Director. I am also a surgeon in the Army National Guard with multiple combat deployments.
In my 24 year career in medicine, I have had the opportunity to work with multiple EMS agencies both integrated and divided. These include the largest volunteer EMS system in the world as well as one of the smallest paid agencies, where I made $9.60/hr as a Paramedic with a four-year degree. I have worked in urban “Knife and Gun Clubs” and in rural Appalachia. Each has had its own rewards and challenges. I highlight my background merely to demonstrate the depth and breadth of experience that informs these statements.
King County’s Medic One program, one of the best EMS agencies in the world, and where we send our paramedics for training, is an integrated system. So is one of the largest Fire/EMS departments in the world, the Fire Department of New York. Historically, the first paramedic agencies in the country were fire-based, to include Los Angeles, Miami, and Columbus. To this day the majority of EMS programs are run through fire departments, and EMS-only agencies make up less than 20% of the EMS providers in this country. In fact, there are only a small handful of public, EMS-only departments left in this state. And there is a reason for that.
Integrated departments are able to provide the right services faster and more efficiently. Because of their structure, integrated departments can respond to more hazards, from more locations, with more personnel. Given the facts above, it is a fallacy to think that fire departments do not, and would not, prioritize EMS response. It is an integral part of their DNA, no different than house fires or car crashes. To highlight that, EMS calls make up 80% of an American fire department’s call volume. The county’s other integrated departments are no different in their call volume. In the time I have interacted with the county chiefs and members, I have never had any indication that EMS would play a subservient role to fire in this integration. It is a merger of equals, with the goal to be to reduce duplication and increase services through thoughtful decisions and prudent spending. Integration, and inter-local agreements, can be a powerful tool.
As an example, FDA medication purchasing guidelines have changed drastically in the past year. No longer can small EMS agencies buy just one or two of a rarely-used medication. Now they must buy them by the case, even if they only use one or two a year. The increase in cost and overhead has been tremendous. As a result, the fire & EMS agencies of the county are exploring ways to integrate our supply chains, allowing for significant improvements in efficiency and decreases in the costs associated with purchasing these life-saving medications. This is integration. This type of cooperation is what we need more of, not less.
Integration streamlines operations, saves money and saves lives. This integration has the chance to pave the way for further cooperation between the agencies not just on this island, but between all the islands in this county. The greatest legacy that we, as EMS leadership, could leave future generations is a county-wide fire/EMS department, where costs and burdens are shared proportionately, and the benefits are realized by everyone in both reduced costs and improved services.
Unlike what some in the community would have you believe, firefighters and EMTs are far more alike than they are different. In fact, a large portion of the membership belongs to both the Fire and EMS departments. Every day they work together cohesively and proudly to serve the citizens of this island. They are united by their passion to serve, no matter emergency, no matter the time. They don’t let the patch on their shoulder define who they are, or define when they will or will not help a neighbor in need. They do the right thing for their neighbors, any time, every time. The membership of both departments have taken great strides to further their training to better themselves and to better the services they deliver. Integration will only serve to increase that training and readiness.
Permanently withdrawing from the ILA and the path towards integration will not stop the increase in cooperation. Nor should it. But it does make that path more challenging, and as a result, makes our firefighters’ and EMTs’ jobs harder. I ask that the PHD ensures that this pause is just that, a pause, and a chance to reset expectations, clear up misunderstandings, and move forward in a thoughtful manner when the time is right.
In conclusion, the commissioners and leadership on both sides should ensure accountability and transparency so that we end up with a combined department that serves the community’s needs and does not sacrifice one function at the expense of the other. Continue with a methodical and logical path towards the integration of fire & EMS. Do it for our volunteers, and most importantly, do it for the citizens of this island we are so privileged to call home.